Finding 1159679 (2024-001)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-10-01

AI Summary

  • Core Issue: The Organization failed to conduct required monthly audits of sliding fee discounts from July to December 2024, impacting compliance with federal regulations.
  • Impacted Requirements: The lack of monitoring may lead to incorrect application of sliding fee discounts, violating the sliding fee discount policy and potentially affecting patient charges.
  • Recommended Follow-Up: Reassess workload priorities to ensure compliance activities are completed and consider implementing additional resources or support to manage auditing responsibilities effectively.

Finding Text

Significant Deficiency in Internal Controls Over Compliance related to Special Tests and Provisions Program Name: Health Center Program Cluster (AL numbers 93.224 and 93.527) Grant Awards: 2 H80CS04210-19-00 from May 1, 2023 through April 30, 2024 and 5 H80CS04210-29-00 from May 1, 2024 through April 30, 2025 Agency: U.S. Department of Health and Human Services, Health Resources and Services Administration Pass-Through Entity: N/AIn accordance with Section 330(k)(3)(G) of the Public Health Services Act (42 U.S. Code § 254b), as an FQHC, the Organization must have a sliding fee discount program in which the Organization’s fee schedule is discounted based on a patient’s ability to pay. In accordance with their policy, the Organization will monitor the accuracy of the discounts provided to patients by a monthly random audit of 15 visits where a sliding fee discount adjustment was received. The Organization did not perform monitoring activities as outlined above from July 2024 through December 2024 as required by the Organization's sliding fee discount policy The Organization was unable to complete the task as expected due to an exceptionally high workload during this period. They were managing multiple priorities, which required their immediate attention, and as a result, were not able to allocate the necessary time to this particular responsibility. It is possible the Organization may not apply sliding fee discounts to patient charges consistent with its sliding fee discount program and these errors may not be detected and corrected in a timely manner.

Corrective Action Plan

To help maintain compliance with the Organization’s sliding fee discount program and related policy, we recommend the Organization strengthen its internal controls by implementing the following: 1. Establish a Formal Monitoring Calendar: Develop and maintain a documented monitoring calendar that includes monthly deadlines and responsible personnel for completing the required audits. This calendar should be reviewed and approved by supervisory staff and integrated into regular compliance reporting. 2. Assign Backup Personnel: Designate and train at least one backup staff member to perform sliding fee discount audits during periods of high workload or staff absences in order to maintain continuity and timely completion of required monitoring activities. 3. Monthly Oversight Review: Require supervisory review and sign-off on the completion of each monthly audit to verify that the monitoring activities were conducted and documented appropriately. Management agrees with the finding and will implement the recommendations above and maintain consistency with their internal monitoring procedures moving forward.

Categories

Subrecipient Monitoring Special Tests & Provisions Significant Deficiency

Other Findings in this Audit

  • 1159676 2024-001
    Material Weakness Repeat
  • 1159677 2024-001
    Material Weakness Repeat
  • 1159678 2024-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $476,891
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $196,670
93.558 Temporary Assistance for Needy Families $195,422
93.959 Block Grants for Prevention and Treatment of Substance Abuse $158,940
14.218 Community Development Block Grants/entitlement Grants $105,881
93.667 Social Services Block Grant $71,364
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $55,438
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $42,052
93.527 Grants for New and Expanded Services Under the Health Center Program $23,332
93.069 Public Health Emergency Preparedness $20,041
93.556 Marylee Allen Promoting Safe and Stable Families Program $19,521
93.991 Preventive Health and Health Services Block Grant $10,453
93.268 Immunization Cooperative Agreements $7,363
93.493 Congressional Directives $5,988
93.994 Maternal and Child Health Services Block Grant to the States $4,153
93.889 National Bioterrorism Hospital Preparedness Program $4,144
93.645 Stephanie Tubbs Jones Child Welfare Services Program $3,582
21.027 Coronavirus State and Local Fiscal Recovery Funds $2,063